an open-source thought experiment in psychedelic law and policy

Vaporizing cannabis prohibition: the gateway theory is gone

The FDA and the DEA abandoned the “gateway theory” in August 2016

No turning back now. Should have just said no.

Newsflash: the “gateway theory” is no longer official government doctrine

There is much concern in the cannabis legalization movement/industry that the new administration will go to war against the legal cannabis markets. The nomination of Alabama Senator Jeff Sessions, recent comments by West Virginia Senator Joe Manchin that we need a “war on drugs” to fight the opioid crisis and that opioid abuse begins with youth experimentation with cannabis, and the reappearance of Reagan drug policy advisor Carlton Turner collectively indicate that we are heading into a time-warp rollback to Reagan/Bush-era prohibition. If so we can expect to see zero tolerance for cannabis (in the guise of “drug prevention”) reascend to its historic place as the cornerstone of national drug control policy.

The “gateway theory” or “steppingstone theory” that experimentation with cannabis inexorably leads to experimentation with and eventual dependence on other substances (opioids, for example, as we see in Senator Manchin’s comments) has been official government doctrine at least since the early 80’s when the “prevention” movement became the key constituency of the federal drug control agencies. (See Dan Baum’s Smoke and Mirrors Chapters 5-6, 8 and 10 for an interesting treatment of the subject.)

On August 11, 2016, the DEA published two decisions each one denying a petition (one by the governors of Rhode Island and Washington State and the other by nurse Bryan Krumm) to hold evidentiary hearings on the proper classification of cannabis under federal law. There was much furor at the time expressed as amazement that the DEA could be so “out of touch” with public attitudes towards cannabis and so oblivious to the new scientific knowledge about cannabis – but, other than my December 19 blogpost, there was no attempt to understand the DEA’s reasoning in concluding that there is no basis even to hold evidentiary hearings.

Lost in the furor, however, was a noteworthy change in official position: the FDA’s report that is the basis for each of the DEA’s decisions states “Overall, research does not support a direct causal relationship between regular marijuana use and other illicit drug use.” See the Federal Register at 81 FR 53688, 53705. The report goes on to say that

First, in general, studies recruit individuals influenced by a myriad of social, biological, and economic factors that contribute to extensive drug abuse.

Second, most studies that test the hypothesis that marijuana use causes abuse of illicit drugs use the determinative measure any use of an illicit drug, rather than DSM-5 criteria for drug abuse or dependence on an illicit drug (DSM-5, 2013). Consequently, although an individual who used marijuana may try other illicit drugs, the individual may not regularly use drugs, or have a diagnosis of drug abuse or dependence. [Emphasis in original.]

Little evidence supports the hypothesis that initiation of marijuana use leads to an abuse disorder with other illicit substances….

Interestingly, the order of initiation of drug use seems to depend on the prevalence of use of each drug, which varies by country…. Specifically, in the countries with the lowest prevalence of marijuana use, use of other illicit drugs before marijuana was common. This sequence of initiation is less common in countries with higher prevalence of marijuana use….

Although many individuals with a drug abuse disorder may have used marijuana as one of their first illicit drugs, this fact does not correctly lead to the reverse inference that most individuals who used marijuana will inherently go on to try or become regular users of other illicit drugs….even if one posits that every cocaine and heroin user previously used marijuana, the [National Survey on Drug Use and Health] data show that marijuana use at least once in a lifetime does not predict that an individual will also use another illicit drug at least once.

Finally, a review of the gateway hypothesis…notes that because the gateway hypothesis only addresses the order of drug use initiation, the gateway hypothesis does not specify any mechanistic connections between drug “stages” following exposure to marijuana and does not extend to the risks for addiction. This concept contrasts with the concept of a common liability to addiction that involves mechanisms and biobehavioral characteristics pertaining to the entire course of drug abuse risk and disorders.

In other words, the United States Government no longer espouses the position that cannabis leads inexorably to experimentation with and addiction to other drugs: the FDA and DEA tag-team just eliminated the major policy argument for maintaining permanent cannabis prohibition. Fascinating, no? The only thing perhaps more fascinating than this development is the fact that it received no attention.

The future into which we head, wherein the world order that has prevailed since 1945 is free-floating or perhaps free-falling, is beyond imagining – with one exception. We can be sure that the gateway theory will return in strength as the prohibitionists come out of hiding. (They never went away, they just went underground, except for Kevin Sabet, who has been keeping the fire alive for the anti-cannabis resistance.) When the proponents of zero tolerance identify cannabis legalization as the cause of the opioid crisis you are equipped to challenge them to explain how that theory works now that two of the most significant agencies in federal drug control have abandoned it.